Panner's Disease: Difference between revisions

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== Definition ==
== Definition ==
Panner's disease is [[bone]] growth disorder (osteochondrosis) of the humeral capitellar ossification centre, at the lateral aspect of the [[elbow]]<ref>Nordlie H, Rognstad M, Iveland H. [https://tidsskriftet.no/en/2021/06/medisin-i-bilder/panners-disease Panner's disease.] Tidsskr Nor Laegeforen. 2021 Jun 24;141(10). English, Norwegian</ref>.  
Panner's disease is [[bone]] growth disorder (osteochondrosis) of the humeral capitellum ossification centre, at the lateral aspect of the [[elbow]]<ref>Nordlie H, Rognstad M, Iveland H. [https://tidsskriftet.no/en/2021/06/medisin-i-bilder/panners-disease Panner's disease.] Tidsskr Nor Laegeforen. 2021 Jun 24;141(10). English, Norwegian</ref>.
 
It is a rare disease, found most commonly in boys under 10 years old, and in a unilateral presentation<ref name=":0">Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. [https://pubmed.ncbi.nlm.nih.gov/25663360/ Panner's disease: literature review and treatment recommendations.] J Child Orthop. 2015 Feb;9(1):9-17.</ref>.  


== Clinically Relevant Anatomy<br>  ==
== Clinically Relevant Anatomy<br>  ==


add text here relating to '''''clinically relevant''''' anatomy of the condition<br>  
The [[elbow]] joint is a synovial hinge joint. The three bones that make up the articulation of the joint are: the distal end of the [[humerus]] and proximal ends of the [[radius]] and [[ulna]]. The capitellum is the smooth,rounded lateral aspect of the distal articular surface of the humerus, which articulates with the head of the radius.<br>  


== Mechanism of Injury / Pathological Process<br> ==
== Pathological Process  ==


add text here relating to the mechanism of injury and/or pathology of the condition<br>  
If the blood vessels suppyling the nuleus of the capitellum are disrupted, ischemia can occur<ref name=":0" />. This could be due to:
 
* Repetitive valgus stress (e.g. throwing and catching).
* Trauma to the elbow.<br>  


== Clinical Presentation  ==
== Clinical Presentation  ==


add text here relating to the clinical presentation of the condition<br>  
* Lateral elbow pain, aggravted by activity and eased with rest<ref name=":1">John Hopkins Medicine. Panner's Disease. Available from: http://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Panner-s-Disease (Accessed 14/10/2022)</ref>.
* Elbow stiffness<ref name=":1" />.
* Elbow swelling<ref name=":1" />.
* <br>  


== Diagnostic Procedures  ==
== Diagnostic Procedures  ==


add text here relating to diagnostic tests for the condition<br>
[[X-Rays|Plain radiographs]] were used for diagnosing Panner's disease.


== Outcome Measures  ==
Initially the capitulum appears irregular with areas of radiolucency (indicating resorption), particularly adjacent to the articular surface, and sclerosis


add links to outcome measures here (see [[Outcome Measures|Outcome Measures Database]])
    - in 3-5 months, radiographs show larger radiolucent areas followed by reconstruction of the bony epiphysis;


== Management / Interventions<br>  ==
    - in 1 to 2 years, the epiphysis returns to its normal configuration with no flattening, presumably because the elbow is not weight bearing joint


add text here relating to management approaches to the condition<br>
    - in about 50% of patients, adjacent radial head shows early maturation compared with the uninvolved elbow


== Differential Diagnosis<br> ==
A ''magnetic resonance imaging'' ([[MRI Scans|MRI]]) scan may show more detail. The MRI can give a better view of bone irregularities and can detect effusion.<br>
== Outcome Measures ==


add text here relating to the differential diagnosis of this condition<br>
[[DASH Outcome Measure|DASH Outcome measure]]


== Resources <br> ==
== Management / Interventions ==


add appropriate resources here
Symptomatic treatment for Panner's disease is sufficient because epiphysis becomes revascularized & develops normal configuration. Reducing elbow activities and avoiding straining activities can help with pain management and healing process. The use of a long arm splint for 3 to 4 weeks may be necessary until pain, swelling, and local tenderness subside. A cast was recommended for an inconsistent period of time ranging from 4 weeks to 11 months.<ref>Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner’s disease: literature review and treatment recommendations. Journal of children's orthopaedics. 2015 Feb 1;9(1):9-17.</ref>Non-steroidal anti-inflammatory drugs  may be helpful.


== References  ==
It takes one to two years for the growth plate that makes up the capitellum to grow into solid bone. At this point, pain and symptoms usually go away completely. Treatments such as heat, [[cryotherapy]], and [[Ultrasound therapy|ultrasound]] may be used to ease pain and swelling.<br>


<references />
== Differential Diagnosis ==


[[Osteochondritis Dissecans|Osteochondritis dissecans]]


== Resources ==


[https://journals.sagepub.com/doi/10.1007/s11832-015-0635-2 Panner's disease: Literature review and treatment recommendations]
== References ==


== Definition ==
<references />
Panner's disease is [[bone]] growth disorder (osteochondrosis) of the humeral capitellar ossification centre, at the lateral aspect of the [[elbow]]<ref>Nordlie H, Rognstad M, Iveland H. [https://tidsskriftet.no/en/2021/06/medisin-i-bilder/panners-disease Panner's disease.] Tidsskr Nor Laegeforen. 2021 Jun 24;141(10). English, Norwegian</ref>.
 
It is a rare disease, found most commonly in boys under 10 years old, and in a unilateral distribution<ref>Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. [https://pubmed.ncbi.nlm.nih.gov/25663360/ Panner's disease: literature review and treatment recommendations.] J Child Orthop. 2015 Feb;9(1):9-17.</ref>.
 
== Clinically Relevant Anatomy ==


The [[elbow]] joint is a synovial hinge joint. Three bones are involved in the articulation of the joint: the distal end of the humerus and proximal ends of the [[radius]] and [[ulna]]. The trochlea at the distal end of the [[humerus]], projects anteriorly and inferiorly at an angle of  45°. The trochlea notch at the proximal ulna, projects anteriorly and superiorly at an angle of 45°. The orientation of these articular surfaces allows a large amount of flexion. It achieves this by delaying contact between the humerus and ulna and providing space for musculature.


== Pathological Process ==


Abnormal valgus stress after the age of 5 years is the most important factor in the development of Panner's disease. The capitellum has a rich vascular supply prior to the age of 5 years. Afterwards, the nucleus of the capitellum is mainly supplied by posterior vessels functioning as end arteries. If those vessels are disrupted by repetitive stress (i.e. throwing), ischaemia can develop. This may result in the disordered endochondral ossification called Panner's disease<ref>Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner’s disease: literature review and treatment recommendations. Journal of children's orthopaedics. 2015 Feb 1;9(1):9-17.</ref>.


== Clinical Presentation  ==
*


* a history of several weeks of pain
== Diagnostic Procedures ==
* stiffness in the elbow
* often with a history of [[Valgus Stress Test|valgus]] stress
* Aggravated with movement and relieved with rest
* effusion and swelling
* Limited range of motion is typically observed with approximately 20° of extension loss and, less commonly, loss of flexion. The duration of symptoms varied from a few months to 2 years.
* The subchondral vacuum phenomenon is a rare finding, but is highly specific to this condition. The vacuum phenomenon, which represents subchondral gas formation, is a sign of bone ischaemia and may indicate aseptic [[necrosis]] <ref>Anisau A, Posadzy M, Vanhoenacker F. Panner’s disease: The vacuum phenomenon revisited. Journal of the Belgian Society of Radiology. 2018;102(1).</ref>


== Diagnostic Procedures  ==
== Outcome Measures  ==  
 
[[X-Rays|Plain radiographs]] were used for diagnosing Panner's disease.
 
Initially the capitulum appears irregular with areas of radiolucency (indicating resorption), particularly adjacent to the articular surface, and sclerosis
 
    - in 3-5 months, radiographs show larger radiolucent areas followed by reconstruction of the bony epiphysis;
 
    - in 1 to 2 years, the epiphysis returns to its normal configuration with no flattening, presumably because the elbow is not weight bearing joint
 
    - in about 50% of patients, adjacent radial head shows early maturation compared with the uninvolved elbow
 
A ''magnetic resonance imaging'' ([[MRI Scans|MRI]]) scan may show more detail. The MRI can give a better view of bone irregularities and can detect effusion.
 
== Outcome Measures  ==
 
[[DASH Outcome Measure|DASH Outcome measure]]


== Management / Interventions ==
== Management / Interventions ==
[[File:Elbow brace.jpg|thumb]]
[[File:Elbow brace.jpg|thumb]]
Symptomatic treatment for Panner's disease is sufficient because epiphysis becomes revascularized & develops normal configuration. Reducing elbow activities and avoiding straining activities can help with pain management and healing process. The use of a long arm splint for 3 to 4 weeks may be necessary until pain, swelling, and local tenderness subside. A cast was recommended for an inconsistent period of time ranging from 4 weeks to 11 months.<ref>Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner’s disease: literature review and treatment recommendations. Journal of children's orthopaedics. 2015 Feb 1;9(1):9-17.</ref>Non-steroidal anti-inflammatory drugs  may be helpful.
<br>   
 
It takes one to two years for the growth plate that makes up the capitellum to grow into solid bone. At this point, pain and symptoms usually go away completely. Treatments such as heat, [[cryotherapy]], and [[Ultrasound therapy|ultrasound]] may be used to ease pain and swelling.<br>  
 
== Differential Diagnosis ==
 
[[Osteochondritis Dissecans|Osteochondritis dissecans]]
 
== Resources ==
 
[https://journals.sagepub.com/doi/10.1007/s11832-015-0635-2 Panner's disease: Literature review and treatment recommendations]


== References  ==
== References  ==


<references />
<references />

Revision as of 11:00, 14 October 2022

Original Editor - Shreya Pavaskar 
Top Contributors - Chloe Waller, Shreya Pavaskar and Vidya Acharya

Definition[edit | edit source]

Panner's disease is bone growth disorder (osteochondrosis) of the humeral capitellum ossification centre, at the lateral aspect of the elbow[1].

It is a rare disease, found most commonly in boys under 10 years old, and in a unilateral presentation[2].

Clinically Relevant Anatomy
[edit | edit source]

The elbow joint is a synovial hinge joint. The three bones that make up the articulation of the joint are: the distal end of the humerus and proximal ends of the radius and ulna. The capitellum is the smooth,rounded lateral aspect of the distal articular surface of the humerus, which articulates with the head of the radius.

Pathological Process[edit | edit source]

If the blood vessels suppyling the nuleus of the capitellum are disrupted, ischemia can occur[2]. This could be due to:

  • Repetitive valgus stress (e.g. throwing and catching).
  • Trauma to the elbow.

Clinical Presentation[edit | edit source]

  • Lateral elbow pain, aggravted by activity and eased with rest[3].
  • Elbow stiffness[3].
  • Elbow swelling[3].

Diagnostic Procedures[edit | edit source]

Plain radiographs were used for diagnosing Panner's disease.

Initially the capitulum appears irregular with areas of radiolucency (indicating resorption), particularly adjacent to the articular surface, and sclerosis

    - in 3-5 months, radiographs show larger radiolucent areas followed by reconstruction of the bony epiphysis;

    - in 1 to 2 years, the epiphysis returns to its normal configuration with no flattening, presumably because the elbow is not weight bearing joint

    - in about 50% of patients, adjacent radial head shows early maturation compared with the uninvolved elbow

A magnetic resonance imaging (MRI) scan may show more detail. The MRI can give a better view of bone irregularities and can detect effusion.

Outcome Measures[edit | edit source]

DASH Outcome measure

Management / Interventions[edit | edit source]

Symptomatic treatment for Panner's disease is sufficient because epiphysis becomes revascularized & develops normal configuration. Reducing elbow activities and avoiding straining activities can help with pain management and healing process. The use of a long arm splint for 3 to 4 weeks may be necessary until pain, swelling, and local tenderness subside. A cast was recommended for an inconsistent period of time ranging from 4 weeks to 11 months.[4]Non-steroidal anti-inflammatory drugs may be helpful.

It takes one to two years for the growth plate that makes up the capitellum to grow into solid bone. At this point, pain and symptoms usually go away completely. Treatments such as heat, cryotherapy, and ultrasound may be used to ease pain and swelling.

Differential Diagnosis[edit | edit source]

Osteochondritis dissecans

Resources[edit | edit source]

Panner's disease: Literature review and treatment recommendations

References[edit | edit source]

  1. ↑ Nordlie H, Rognstad M, Iveland H. Panner's disease. Tidsskr Nor Laegeforen. 2021 Jun 24;141(10). English, Norwegian
  2. ↑ 2.0 2.1 Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner's disease: literature review and treatment recommendations. J Child Orthop. 2015 Feb;9(1):9-17.
  3. ↑ 3.0 3.1 3.2 John Hopkins Medicine. Panner's Disease. Available from: http://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Panner-s-Disease (Accessed 14/10/2022)
  4. ↑ Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner’s disease: literature review and treatment recommendations. Journal of children's orthopaedics. 2015 Feb 1;9(1):9-17.



Diagnostic Procedures[edit | edit source]

Outcome Measures[edit | edit source]

Management / Interventions[edit | edit source]

Elbow brace.jpg


References[edit | edit source]

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